Abnormal uterine bleeding as a presenting sign of metastases to the uterine corpus, cervix and vagina in a breast cancer patient on tamoxifen therapy

Metastases to the female genital tract from extragenital cancers are uncomm on. The ovaries are most often affected with the breast and gastrointestina l tract being the most common sites of the primary malignancy. Metastases t o the uterus from extragenital cancers are significantly rarer than metasta ses to the ovaries and in the majority of cases the ovaries are also involv ed. A case of metastases restricted to the uterine corpus, cervix and vagin a from breast carcinoma, without involvement of the ovaries, is described. The patient who had been on tamoxifen therapy presented with postmenopausal bleeding. The diagnosis of uterine metastases was established during endom etrial ablation and confirmed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. This case illustrates that abnormal uterine bleedin g in a breast cancer patient, regardless of whether she is receiving or not receiving tamoxifen, should always alert the physician to consider the pos sibility of uterine metastases from breast carcinoma. (C) 1999 Elsevier Sci ence Ireland Ltd. All rights reserved.